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Physical inactivity is the most important unhealthy lifestyle factor for pain severity in older adults with pain: A share-based analysis of 27,528 cases from 28 countries. Núñez-Cortés, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : Persistent pain - Physical activity This cross sectional study assessed the association between physical activity and pain severity in older adults using data from Survey of Health, Ageing and Retirement in Europe (SHARE) dataset. In this study, a total of 27,528 participants over 50 years old from multiple European countries were included. Variables such as demographics, co-morbidities, pain sites, physical activity, sleep problems, diet, and smoking were collected. The results showed that low levels of physical activity were strongly correlated with severe pain. Other lifestyle factors such as sleep problems, smoking, and inadequate diet were associate with pain levels too, however, to a lesser extent. Keep in mind that correlation is not causation. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, there is a significant association between physical activity levels and pain severity in older adults, with physical inactivity emerging as a key determinant of severe pain. The bidirectional relationship between pain and physical activity highlights suggests the potential importance of addressing both pain levels as well as increasing physical activity levels in sedentary people. Remember that physical activity does not necessarily need to be pain-free, as pain whilst exercising does not appear to have a detrimental effect in people with musculoskeletal conditions . URL : https://doi.org/10.1016/j.msksp.2025.103270 Abstract Background: Limited knowledge exists on the association between lifestyle factors and pain severity in older adults. Objective: To assess the associations between unhealthy lifestyle variables and pain severity in the European population of older adults with pain. Design: Cross-sectional. Methods: Data were retrieved from the ninth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), a representative survey of individuals aged >50 years living in 27 European countries and Israel. Associations between lifestyle factors (sleep, smoking, diet and physical inactivity) and pain severity (mild, moderate, severe) were assessed using multivariable multinomial regression adjusted for age, sex, geographic region, education, history of chronic disease and mutually adjusted for each lifestyle. Results: 27,528 cases were included (73.1 ± 9.76 years; 63.3% female). A significant association was observed between those who hardly ever or never engaged in activities that required a moderate level of energy and severe pain (OR: 4.35; 95% CI: 3.85 to 4.92). Sleep problems (OR: 1.83; 95% CI: 1.69 to 1.99), smoking (OR: 1.21; 95% CI: 1.13 to 1.34) and an inadequate diet (OR: 1.78: 95% CI: 1.22 to 2.61) were also significantly associated with severe pain, but with lower odds. Given the cross-sectional design, the bidirectionality of these relationships should be considered. Conclusion: Physically inactive older adults were particularly more likely to experience severe pain, while other lifestyle factors were more weakly associated with pain. As these lifestyle factors are modifiable, the results may be useful in prioritising appropriate preventive measures to attenuate pain and ensure healthy ageing. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The displaced fleck sign: Description of a radiographic finding consistent with grade III thumb ulnar collateral ligament tears with Stener lesions. Daryoush, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Fleck sign - Stener lesion This was a retrospective review of patients presenting with a ulnar collateral licament (UCL) lesion at the mcpj of the thumb. A total of 228 patients with acute UCL lesions were included. Amongst these patients, a small proportion (n =17, 7.5%) had a small avulsion fragment displaced proximal to the joint line on the ulnar side called "fleck sign". All of these patients were clinically unstable. Of these, 14 patients had evidence of Stener lesion intra-operatively. Interestingly, an additional 19 patients who did not present with a fleck sign, had evidence of a Stener lesion intra-operatively. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the displaced fleck sign is highly suggestive of a Stener lesion, warranting immediate surgical repair, especially if patients are willing to undergo such treatment . Nevertheless, the absence of a fleck sign on x-ray does not exclude a Stener lesion. In this last subgroup, it may be worth trialing eight weeks of immobilisation followed by re-assessment. Thus, it does not seem that delaying surgery has negative repercussions on people's functional outcomes . Furthermore, advanced imaging may present with limitations which reduce their relevance in the diagnosis of this condition . URL : https://doi.org/10.1016/j.jhsa.2024.12.003 Abstract Purpose: Controversy exists regarding the optimal imaging modality (magnetic resonance imaging, ultrasound, stress radiographs) for identification of patients with grossly unstable thumb metacarpophalangeal (MCP) ulnar collateral ligament (UCL) injuries or Stener lesions. We characterize a radiographic sign for this purpose. The “displaced fleck sign” is a small avulsion fracture from the ulnar proximal phalanx base that is displaced proximal to the MCP joint line. Methods: Patients with thumb UCL injuries evaluated by hand surgeons were identified at a single, tertiary institution. Patients who were skeletally immature, had chronic injuries (>3 months old), and those with MCP arthritis were excluded. Two attending hand surgeons independently reviewed radiographs to identify the displaced fleck sign. Presence/absence of a Stener lesion was extracted from operative notes. Results: Of 228 patients, 17 (7.5%) had a positive displaced fleck sign. Excellent interobserver reliability was observed (κ = 0.94). All 17 (100%) demonstrated gross instability with no end point in clinic, and all underwent surgical repair. Grade III ruptures were noted for all. Specifically, 14 (94.1%) had a Stener lesion, and one patient (7%) had a bony avulsion from the metacarpal. The displaced fleck sign had a positive predictive value of 100% for Grade III rupture and 94.1% for a Stener lesion. Conclusions: Presence of a displaced fleck sign has implications for offering surgery to patients with thumb UCL injuries because of a high likelihood of a Stener lesion. When present, surgeons may consider proceeding with surgical repair without additional imaging and associated follow-up visits. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Reliability and validity of the ten test for the assessment of digit sensation. Ozdag, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Ten Test - Sensory loss This study evaluates the reliability and validity of the Ten Test for assessing digit sensation compared to two-point discrimination (2PD). The Ten Test involves patients rating their finger sensation on a 1-10 scale, using an unaffected finger as a reference. A total of 201 participants, who had some injury to the affected side (no detailed information is provided in this regard), self-assessed the sensation on the affected hand across all the five finger tips. Their assessment was compared to a clinician assessment of 2PD. The results showed that the Ten Test had low sensitivity (53%) and reasonable specificity (84%) when compared to 2PD. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the Ten Test is a low quality option to the two-point discrimination test when assessing light touch in our patients. This test may be useful when remote consultations are completed. Remember that both two-point discrimination and light touch only test a subgroup of large nerve fibres and that for milder entrapment neuropathies you are more likely to only have changes in small fibre, which can be assessed with pinprick . URL : https://doi.org/10.1016/j.jhsa.2024.12.015 Abstract Purpose: The ten test (TT) is a sensory assessment used to quantify the sensation of each digit. Because it does not require additional equipment, it may have utility in telemedicine. Our purpose was to evaluate the validity and reliability of the TT. Methods: Adult patients with nontrauma upper-extremity complaints were evaluated within an academic outpatient clinic. Two examiner groups (hand surgeons [group 1] and residents/physician assistants [group 2]) administered the TT and static two-point discrimination (2PD). Hand surgeons were blinded to the results obtained by the initial examiners. The TT is administered by having the patient define an area of normal sensation with their uninvolved index finger and then rate digital sensation against the involved hand on a 1–10 scale, with 10 defined as perfectly normal sensation. A cut-point analysis was employed, and both sensory assessments were categorized as either normal (2PD ≤5 mm, TT ≥9) or abnormal sensation for the entire median-nerve distribution and individual digit level. Agreement statistics including sensitivity (Sn) and specificity (Sp) were calculated for the TT, using static 2PD as the reference standard. Interrater reliability was compared between the groups of examiners. Results: A total of 201 patients (1,005 digits) were examined. The Sn/Sp for the TT was 53%/84% and 54%/85% at the digit-level and median-nerve distribution level, respectively. Interrater reliability for the TT between the groups of examiners was substantial at the digit level (κ = 0.68, SE = 0.02). Conclusions: The Sn/Sp for the TT was 53%/84% when using static 2PD as the reference standard. Interrater reliability for TT was substantial (κ = 0.68). The TT can serve as an alternative to other sensory assessments that require instrumentation. As telemedicine programs continue to evolve within upper-extremity surgery, the TT may be a useful tool with virtual applications. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Early postoperative complications following partial distal biceps tendon surgical repair. Fones, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Partial distal biceps tears - Surgical repair This retrospective study assessed the complication rate after surgery for partial distal biceps. A total of 112 participants underwent the partial biceps repair. The most common repair approach (106 participants) involved the full detachment of the biceps and re-attachment, whilst a small proportion of participants underwent repair of the partial tear only. A total of 21% of people had complications. The most common complication included sensory deficits of the musculocutaneous nerve whilst a few more severe complications included re-ruptures, infections, and joint stiffness. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, 1 in 5 people with have minor to severe complications following a distal biceps repair. Sensory involvement of the lateral cutaneous branch of the musculocutaneous nerve is the most common complication. Less frequent complications included re-ruptures, infections, and joint stiffness due to heterotopic ossificaiton. These findings appear to be in line with previous evidence . Given the potential complications, distal biceps repairs, especially if they are partial tears only, should be reserved for very active individuals only . URL : https://doi.org/10.1016/j.jhsa.2025.04.012 Abstract Purpose: There are sparse data on complications following partial distal biceps tendon (PDBT) repair. The purpose of this study was to analyze the early complication rate following operative repair of PDBT tears. We hypothesized that a minority of patients would experience a complication and that most complications would be minor and self-limited, regardless of surgical technique. Methods: A retrospective chart review identified patients treated with surgical repair of PDBT tears at a large orthopedic subspecialty practice over a 6-year period. Patients’ records were reviewed for surgical approach and method, demographics, and complications. Complications were classified as major if they necessitated reoperation within 12 weeks. Results: In total, 112 patients underwent PDBT repair via either a single-incision (71 patients; 63.4%) or two-incision (41 patients; 36.6%) technique. Within the first 3 months after surgery, complications were noted in 23 patients (rate 20.5%); 19 (82.6%) were minor, and four (17.4%) were major complications requiring return to the operating room within 12 weeks. Most minor complications were sensory nerve symptoms (56.5%). The rate of sensory symptoms was significantly higher with the single-incision (16.9%; 12/71) compared to two-incision technique (2.4%; 1/41). Major complications included two acute reruptures, one vascular injury, and one deep infection requiring anterior incision irrigation and debridement. Of the 13 patients with sensory symptoms, two later underwent removal of hardware and neurolysis for persistent symptoms outside the acute postoperative period. Conclusions: The early complication rate following PDBT repair was 20.5%. Of the patients who experienced complications, 83% were considered minor, and 90% of minor complications resolved without additional surgical intervention. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

An update on osteoporosis screening: Advances, applications, and the role of hand surgeons and allied health providers. Luan, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Diagnostic Topic : Osteoporosis screening - Who needs it? This osteoporosis screening updated discusses recent advancements and insights from orthopedic literature regarding osteoporosis and fragility fractures, particularly focusing on wrist and hand injuries. Research highlights the importance of bone mineral density (BMD) assessment in diagnosing osteoporosis, with studies demonstrating the effectiveness of using hand radiographs for BMD evaluation. These methods show promise as non-invasive screening tools for identifying individuals at risk of fractures. Additionally, several studies emphasise the relationship between wrist fractures and an increased likelihood of subsequent fractures, underscoring the need for early intervention and comprehensive management plans. The literature also highlights gender-specific differences, particularly noting that men often receive inadequate evaluation and treatment following wrist injuries, indicating missed opportunities for addressing underlying osteoporosis. Below you can find a set of screening criteria. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, early identification and intervention in patients with underlying osteopenia/osteoporosis who present to our clinic with hand fractures is warranted. You can easily calculate an estimate of bone density from a hand x-ray by looking at the second metacarpal . A simple assessment utilising the FRAX may also be useful . Screening our patients for osteopenia/osteoporosis may improve their quality of life and health since the screening itself appears to be associated with a reduction in the probability of additional fractures . Remember that if our patients are willing to go to the gym, heavy lifting has been shown to improve bone mass density by a significant amount . URL : https://doi.org/10.1016/j.jhsa.2025.05.009 Abstract Osteoporosis and osteopenia are highly prevalent and undertreated. Both are characterized by low bone mineral density and contribute to fragility fractures and their subsequent morbidity and mortality. Recent advances in diagnostic modalities and pathways have demonstrated the potential to expand screening and treatment for patients with low bone mineral density. Hand surgeons will encounter patients with osteoporosis and osteopenia regardless of whether they have sustained fragility fractures and therefore must maintain an understanding of diagnostic and management considerations. This article provides an updated review on current methods of screening and the role of the hand surgeon in the evaluation and treatment of osteoporosis and osteopenia. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Prognostic factors for poor recovery in active-duty military personnel with musculoskeletal disorders: A systematic review with meta-analysis. Olivotto, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Better recovery determinants - Musculoskeletal conditions The systematic review and meta-analysis assessed prognostic factors for recovery from musculoskeletal disorder amongst active military personnel. A total of 28 studies, which included retrospective and prospective designs were included. The Cochrane Risk of Bias criteria was utilised to assess each study. The findings suggested that low initial pain intensity and the absence of psychiatric disorders (e.g. anxiety or depression) were positive prognostic factors in recovery from musculoskeletal conditions. Prognostic factors for short-term restricted duty. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, lower initial pain levels and the absence of depression/anxiety are positive prognostic factors in the recovery from musculoskeletal conditions. These findings are in line with the paper by Aasdahl et al. (2021) , which showed that the overall trajectory of pain was similar across multiple musculoskeletal presentations and higher levels of initial pain intensity were associated with persistent pain. In addition, a large amount of previous evidence has shown the greater levels of depression and anxiety are associated with a greater disease burden. Don't forget that having better social determinants of health also help with the overall recovery of patients. URL : https://doi.org/10.1016/j.msksp.2025.103383 Abstract Background: Military personnel are twice as likely as civilians to experience chronic musculoskeletal pain. Identifying prognostic factors for poor recovery from musculoskeletal disorders may support the development of tailored care pathways to improve outcomes. Objectives: Identify prognostic factors for poor recovery in active military personnel with musculoskeletal disorders. Design: Systematic review of prognostic studies including prospective, retrospective, and secondary analyses of randomised controlled trials. Methods: MEDLINE, EMBASE, AMED, PsychInfo, Cinahl, Scopus, and SPORTDiscus databases were searched from inception to March 2025. Studies were included if they evaluated prognostic factors for association with recovery outcomes (pain, disability, work status, or perceived recovery) in active military personnel with any musculoskeletal disorder. Two reviewers independently screened eligible studies and assessed methodological quality using the Quality in Prognostic Studies (QUIPS) tool. Descriptive analysis of multivariate data was undertaken with meta-analyses performed where possible. Results: Twenty-eight studies were included in this review. The factor most strongly associated with poor short-term outcome (disability) was initial pain severity [OR 3.88 (95 %CI 1.50–10.07)] followed by male sex (outcome restricted duty) [OR 2.63 (95 %CI 1.57–4.40)]. The factor most strongly associated with poor long-term outcome (restricted duty) was the presence of comorbid psychiatric diagnosis [RR 6.02 (95 % 4.25–8.51)]. Conclusions: Assessing initial pain severity and psychological stressors may help clinicians identify military personnel with musculoskeletal disorders at risk of poor outcome. Understanding the interaction between occupational psychological stressors and pain symptoms may identify modifiable factors that can be targeted to improve recovery. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Associations of computer gaming with incident dementia, cognitive functions, and brain structure: A prospective cohort study and Mendelian randomization analysis. Jia, et al. (2024) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Computer gaming - Cognitive decline This was a prospective study assessing the association between computer gaming frequency and cognitive functions, brain structure, and dementia risk using data from the UK Biobank. A total of 471,346 participants were included in the study. People were followed up for an average of 14 years and were asked whether they played games at baseline and if so how frequently. The results indicated that higher computer gaming frequency was associated with better cognitive performance, favorable brain structure (e.g., increased gray matter volume), and a reduced risk of dementia. These results were still holding after controlling for several confounders such as age, social deprivation, educational level, and physical activity. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, frequent computer gaming seems to be protective for dementia. Hence, we might encourage our older patients to engage in regular game play, which seems to be much better than watching TV . It goes without saying that sedentary activities should be balanced with physical activity as per WHO and heavy lifting and impact to improve or maintain our bone mass density . URL : https://doi.org/10.1186/s13195-024-01496-7 Abstract Background: Computer gaming has recently been suggested to be associated with benefits for cognition, but its impact on incident dementia remains uncertain. We aimed to investigate the observational associations of playing computer games with incident dementia, cognitive functions, and brain structural measures, and further explore the genetic associations between computer gaming and dementia. Methods: We included 471,346 White British participants without dementia at baseline based on the UK Biobank, and followed them until November 2022. We estimated the risk of dementia using Cox proportional hazard models, and assessed the changes of cognitive functions and brain structural measures using logistic regression models and linear regression models. Mendelian randomization (MR) analyses were performed to examine the association between genetically determined computer gaming and dementia. Results: High frequency of playing computer games was associated with decreased risk of incident dementia (HR, 0.81 [95% CI: 0.69, 0.94]). Individuals with high frequency of playing computer games had better performance in prospective memory (OR, 1.46 [1.26, 1.70]), reaction time (beta, -0.195 [-0.243, -0.147]), fluid intelligence (0.334 [0.286, 0.382]), numeric memory (0.107 [0.047, 0.166]), incorrect pairs matching (-0.253 [-0.302, -0.203]), and high volume of gray matter in hippocampus (0.078 [0.023, 0.134]). Genetically determined high frequency of playing computer games was associated with a low risk of dementia (OR, 0.37 [0.15, 0.91]). Conclusions: Computer gaming was associated with a decreased risk of dementia, favorable cognitive function, and better brain structure, suggesting that computer gaming could modulate cognitive function and may be a promising target for dementia prevention. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Effectiveness of splinting after percutaneous needle fasciotomy for dupuytren’s contracture. Mon, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Splinting - Percutaneous needle fasciotomy This was a short systematic review assessing the effect of splinting after percutaneous needle fasciotomy for Dupuytren’s contracture. A total of 171 participants from four studies of which one was a retrospective, two were prospective, and one was a randomised controlled trial were included in the research. The results showed heterogeneity in splinting use, including variations in splint duration (from a few weeks to 3 months) and the absence of standardised measures for reporting contractures. Overall there did not appear to be a significant effect of splinting on functional outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, splinting after percutaneous needle fasciotomy for Dupuytren’s contracture does not appear to be necessary. These findings appear to be in line with a previous systematic review . Despite these findings, in rare instances, it may be beneficial to provide the patient with a splint and we have a few options . If we are considering patients who are not ready for surgery yet, splinting may have some benefits . URL : https://doi.org/10.1177/17531934251350463 Abstract This review of 220 patients evaluates the effectiveness of splinting after percutaneous needle fasciotomy in reducing the total passive extension deficit, highlights inconsistent evidence and recommends individualized care. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Development and validation of a severity-focused score for the assessment of lateral epicondylitis using enhanced magnetic resonance imaging. Lee, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : MRI and symptoms - CEO tendinopathy This retrospective the correlation between magnetic resonance imaging (MRI) and lateral epicondylalgia symptoms. A total of 80 students with symptomatic lateral elbow pain were included in the study. All of the participants had undergone MRI. A series of measures, which included T2 and T1 MRI images were found to be useful for in estimating disease severity. In particular, a combined score based on the size of tear, neo-angiogenesis, involvement of all or some tendons of the CEO, and subcutaneous fat were utilised to provide a disease estimate. The results showed that a greater level of change within the CEO and sorrounding tissues, the higher the level of symptoms in this cohort of patients. Keep in mind that this was a small study without a large validation dataset. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, there is a small to moderate correlation between changes on MRI and symptoms of lateral epicondylalgia. These findings appear to be in line with the paper by Songur et al. (2025) and Clarke et al. (2010) , showing that larger tears at the CEO are associated with a poorer prognosis in people with lateral epicondylalgia. It is possible that surgery in these cases may be more suitable, although it has been shown that surgery for persistent CEO tendinopathy is not usually more effective than sham surgery . URL : https://doi.org/10.1016/j.jse.2025.01.052 Abstract Background: Magnetic resonance imaging (MRI) does not sufficiently reflect the severity of lateral epicondylitis. Although some authors have reported meaningful findings on conventional MRI, it is not widely accepted that MRI is useful for evaluating lateral epicondylitis. The aim of this study is to evaluate the relationship between the lateral epicondylitis severity score (LESS) using contrast-enhanced T1-weighted MRI and patients' perceptive pain and clinical courses. Methods: This retrospective study included 80 patients diagnosed with lateral epicondylitis and who also went contrast-enhanced 3.0-T MRI. The study cohort was split into a development (n = 50) and a validation cohort (n = 30). The patient's pain was assessed using a visual analog scale (VAS), and the involvement of the common extension tendon (CET) origin, radial collateral ligament, lateral ulnar collateral ligament, and plica were evaluated using T2-weighted images. The enhancement of CET and subcutaneous tissue was scored using a novel classification in the contrast-enhanced T1-weighted MRI. LESS was calculated from MRI findings to determine the severity of lateral epicondylitis. Pearson's correlation analysis was performed to evaluate the relationship between patients' VAS scores and MRI findings. Receiver operating characteristic curve was constructed to determine cut-off value of LESS for the surgical treatment of lateral epicondylitis. Results: The average age of the development cohort (n = 50) and the validation cohort (n = 30) were 49.8 (31-66) years and 52.3 (37-67) years, and the average VAS score were 7.3 (4-9) and 7.2 (5-10) respectively. In T2-weighted image evaluation, the correlation of VAS and grade of CET, radial collateral ligament, lateral ulnar collateral ligament, and plica were −0.03 ( P  = .87), −0.03 ( P  = .87), −0.14 ( P  = .39), and 0.36 ( P = .02). Discordant contrast enhancement in T1-weighted images compared to nonspecific T2-weighted images was observed in 46 of 50 cases (92%). A statistically significant correlation was observed between the patients' VAS and LESS scores (r = 0.67, P  < .01). Area under curve was 0.76 ( P < .01) and the optimal cut-off value of LESS for the surgical treatment of lateral epicondylitis was 5.5 (sensitivity 72.7%, specificity 70.6%). When the cut-off value was used to predict surgical treatment in the validation cohort, the sensitivity was 100% and the specificity was 75%. Conclusion: Contrast-enhanced T1-weighted images provided more detail than conventional T2-weighted images in evaluation of structural or unobserved abnormalities to assess the severity of the lateral epicondylitis, and had excellent inter- and intraobserver reliability. LESS showed significant positive correlation with pain severity. If the LESS is 5.5 or more, surgical treatment of lateral epicondylitis may need to be considered. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Associations between partial common extensor tendon tears and clinical-ultrasonographic findings in patients with lateral epicondylitis. Songur, et al. (2025) Level of Evidence : 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : CEO tears - Symptoms levels This retrospective study assessed ultrasound (US) imaging features associated with worse levels of pain in people with lateral epicondylalgia (LE). A total of 227 participants with LE were reviewed. The imaging assessed features like tendon thickness, tears, and bony irregularities. About 20% of the participants presented with tears within the common extensor origin tendon. Whilst accounting for several other variables, it appears that age as well as pain were associated with the presence of tendon tears. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, 1 in 5 people with lateral epicondylalgia present with common extensor origin tears. In these instances it appears that, whilst accounting for age, the pain is higher compared to people without a tear . These findings appear to be in line with previous evidence suggesting that larger tears are associated with greater symptoms . If you would like to know more about lateral epicondylalgia, have a look at the entire database . URL : https://doi.org/10.1097/PHM.0000000000002655 Abstract Objective: This study investigates the effect of partial common extensor tendon tears on demographic, clinical and ultrasound parameters in patients with lateral epicondylitis. The research aimed to provide a comprehensive understanding of how these ultrasound-detected partial tears influence the clinical presentation and imaging findings associated with lateral epicondylitis. Design: This is a retrospective cross-sectional study. Records of 227 patients with lateral epicondylitis met the inclusion-exclusion criteria were reviewed. The patient-rated tennis elbow evaluation questionnaire was used as the primary outcome measure. Secondary outcome measures were visual analog scale for pain, algometric measurements, hand grip strength, and ultrasound parameters (maximum tendon thickness measurements from the capitellar-radiocapitellar sides and presence of bone abnormalities). Results: Partial common extensor tendon tears detected using ultrasound were present in 22.7% (n = 54) of the patients. Patients with partial common extensor tendon tears were older (50,31 ± 9,22), had higher patient-rated tennis elbow evaluation scores (65,48 ± 12,76), capitellar-radiocapitellar maximum tendon thickness measurements (0,60 ± 0,80/0,60 ± 0,72), and incidence of bone abnormalities (40.7%, n = 32) (P < 0.05). Logistic regression analysis identified age and patient-rated tennis elbow evaluation pain score as associative factors with partial common extensor tendon tears. Capitellar-radiocapitellar maximum tendon thickness measurements greater than 0.55 cm were associated with an increased probability of partial common extensor tendon tears. Conclusions: Ultrasound-detected partial common extensor tendon tears may worsen the clinical and ultrasound parameters in patients with lateral epicondylitis. Older age, higher patient-rated tennis elbow evaluation scores, and higher maximum tendon thickness measurements were associated with partial common extensor tendon tears. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Effectiveness of painful versus non-painful exercise on pain intensity, disability, and other patient-reported outcomes in adults with chronic musculoskeletal pain: An updated systematic review with meta-analysis. Tran, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Painful vs pain-free exercise - Persistent pain This systematic review and meta-analysis assessed the effects of painful versus non-painful exercise on adults with persistent musculoskeletal pain. A total of 16 trials for more than a 1,000 participants were included. The articles were assessed through the Cochrane Risk of Bias criteria and the Grading of Recommendations Assessment Development and Evaluation (GRADE) for the overall quality of evidence. The results showed very low to low certainty evidence suggesting no difference in effectiveness or safety between painful vs not-painful exercise interventions. There were no significant differences on patient-reported outcomes or adverse events. Forest plot for pain intensity Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, painful exercise in people with chronic musculoskeletal pain does not appear to be inferior to pain-free exercise. Getting people to exercise with some pain may even be beneficial in reducing fear of movement, which has been shown to influence upper limb function . This may also have a positive effect on pain catastrophising , which is another important mindset in upper limb recovery. URL : https://doi.org/10.2519/jospt.2025.13253 Abstract OBJECTIVE: To determine the effect of painful versus non-painful exercise on pain, disability, and other patient-reported outcomes in adults with chronic musculoskeletal pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Electronic databases (CENTRAL, EMBASE, CINAHL, PubMed and PsycINFO) and trial registers (ClinicalTrials.gov, ANZCTR, World Health Organization International Clinical Trials Registry Platform) were searched from October 2016 to May 2024. STUDY SELECTION CRITERIA: Randomized controlled trials that compared painful exercise to non-painful exercise in adults with chronic musculoskeletal pain. DATA SYNTHESIS: Data were analyzed using random effects meta-analysis and narrative synthesis. We assessed risk of bias using the Cochrane RoB2 tool and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS: We included 16 trials (reported across 18 studies). There was no difference in the effect of painful versus non-painful exercise on pain intensity or disability in the short-, medium-, or long-term, nor pain catastrophizing or fear avoidance in the short-term. The confidence intervals were wide. Narrative synthesis found similar results for quality of life, self-efficacy, mood, and adverse events. All trials were at high risk of bias and certainty of evidence was very low to low. CONCLUSIONS: The effect of painful versus non-painful exercise on patient-reported outcomes in adults with chronic musculoskeletal pain was unclear. Pain during exercise may not need to be avoided to allow for symptomatic and functional improvement. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Clinical thumb ulnar collateral ligament injury owing to a pathological fracture through an enchondroma of the proximal phalanx. van de Lucht, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic : Enchondroma - Fracture A 27-year-old woman had a fall and was subsequently unable to move their thumb. They reported thumb pain prior to the traumatic event, but x-rays taken two years prior were clear. On objective assessment, there was laxity of the ulnar collateral ligament of the thumb mcpj. X-ray were completed and they are reported below. A lobulated, osteolytic lesion in the proximal phalanx was diagnosed as an enchondroma with an intra-articular fracture. Surgical intervention was performed one week post-injury, involving bone grafting and fracture fixation. Histopathological analysis confirmed a benign enchondroma. The thumb was immobilised for six weeks before rehabilitation began. X-rays at three months showed successful healing and functional recovery, with comparable range of motion to the contralateral thumb. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, traumatic events associated with objective ligament lesions, should be assessed via x-ray, especially if the injury is caused by low energy trauma. In the case of fractures through enchondromas, before surgical excision of the lesion, the fracture is allowed to heal for 6-8 weeks, however, in this case, due to the joint instability, an earlier intervention was preferred. Can you identify whether there are any abnormalities in this other group of x-rays? URL : https://doi.org/10.1177/17531934251315313 Abstract A young woman presented with an acute ulnar collateral ligament injury of the thumb, owing to a pathological fracture through an enchondroma. Treatment included bone graft and fracture fixation, with successful healing and functional recovery. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings